The calibrated automated thrombogram (CAT or CT) is a thrombin generation assay (TGA) and global coagulation assay (GCA) which can be used as a coagulation test to assess thrombotic risk.[1][2] It is the most widely used TGA.[3] The CAT is a semi-automated test performed in a 96-well plate and requires specialized technologists to be performed.[3] As a result, it has seen low implementation in routine laboratories and has been more limited to research settings.[3][4] Lack of standardization with the CAT has also led to difficulties in study-to-study comparisons in research.[3][5] However, efforts have recently been made towards standardization of the assay.[5][6][7][8] An example of a specific commercial CAT is the Thrombinoscope by Thrombinoscope BV (now owned by Diagnostica Stago).[9]

The CAT can be used to measure thrombogram parameters such as the endogenous thrombin potential (ETP)[2][10] and to assess activated protein C resistance (APCR).[5] The CAT ETP-based APC resistance test is especially sensitive to estrogen-induced procoagulation, such as with combined oral contraceptives.[2][5][11]

In 2018, a commercial fully-automated TGA system and alternative to the CAT called the ST Genesia debuted.[3] It has been said that this system should allow for more widespread adoption of TGAs in clinical laboratories.[3][12] The ST Genesia system also shows improved reproducibility compared to the CAT.[3]

References

  1. ↑ Hemker HC, Giesen P, AlDieri R, Regnault V, de Smed E, Wagenvoord R, Lecompte T, Béguin S (2002). "The calibrated automated thrombogram (CAT): a universal routine test for hyper- and hypocoagulability". Pathophysiol Haemost Thromb. 32 (5–6): 249–53. doi:10.1159/000073575. PMID 13679651. S2CID 8378673.
  2. 1 2 3 Lim HY, Donnan G, Nandurkar H, Ho P (January 2022). "Global coagulation assays in hypercoagulable states". J Thromb Thrombolysis. 54 (1): 132–144. doi:10.1007/s11239-021-02621-1. PMID 34997471. S2CID 245804095.
  3. 1 2 3 4 5 6 7 Reda S, Morimont L, Douxfils J, Rühl H (August 2020). "Can We Measure the Individual Prothrombotic or Prohemorrhagic Tendency by Global Coagulation Tests?". Hamostaseologie. 40 (3): 364–378. doi:10.1055/a-1153-5824. PMID 32726831. S2CID 220878363.
  4. ↑ Lim HY, Leemaqz SY, Torkamani N, Grossmann M, Zajac JD, Nandurkar H, Ho P, Cheung AS (July 2020). "Global Coagulation Assays in Transgender Women on Oral and Transdermal Estradiol Therapy". J Clin Endocrinol Metab. 105 (7): e2369–e2377. doi:10.1210/clinem/dgaa262. PMID 32413907. S2CID 218659931.
  5. 1 2 3 4 Morimont L, Haguet H, Dogné JM, Gaspard U, Douxfils J (2021). "Combined Oral Contraceptives and Venous Thromboembolism: Review and Perspective to Mitigate the Risk". Front Endocrinol (Lausanne). 12: 769187. doi:10.3389/fendo.2021.769187. PMC 8697849. PMID 34956081.
  6. ↑ Douxfils J, Morimont L, Delvigne AS, Devel P, Masereel B, Haguet H, Bouvy C, Dogné JM (January 2020). "Validation and standardization of the ETP-based activated protein C resistance test for the clinical investigation of steroid contraceptives in women: an unmet clinical and regulatory need". Clin Chem Lab Med. 58 (2): 294–305. doi:10.1515/cclm-2019-0471. PMID 31444961. S2CID 201644826.
  7. ↑ Morimont L, Bouvy C, Delvigne AS, Dogné JM, Douxfils J (April 2020). "Proof of concept of a new scale for the harmonization and the standardization of the ETP-based APC resistance". J Thromb Haemost. 18 (4): 895–904. doi:10.1111/jth.14745. PMID 31984653. S2CID 210922482.
  8. ↑ Morimont L, Didembourg M, Haguet H, Modaffari É, Tillier M, Bouvy C, Lebreton A, Dogné JM, Douxfils J (October 2021). "Interlaboratory variability of activated protein C resistance using the ETP-based APC resistance assay". Res Pract Thromb Haemost. 5 (7): e12612. doi:10.1002/rth2.12612. PMC 8563922. PMID 34761157.
  9. ↑ Kintigh J, Monagle P, Ignjatovic V (January 2018). "A review of commercially available thrombin generation assays". Res Pract Thromb Haemost. 2 (1): 42–48. doi:10.1002/rth2.12048. PMC 6055498. PMID 30046705.
  10. ↑ Duarte RC, Ferreira CN, Rios DR, Reis HJ, Carvalho MD (2017). "Thrombin generation assays for global evaluation of the hemostatic system: perspectives and limitations". Rev Bras Hematol Hemoter. 39 (3): 259–265. doi:10.1016/j.bjhh.2017.03.009. PMC 5568585. PMID 28830606.
  11. ↑ Tchaikovski SN, Rosing J (July 2010). "Mechanisms of estrogen-induced venous thromboembolism". Thromb Res. 126 (1): 5–11. doi:10.1016/j.thromres.2010.01.045. PMID 20163835.
  12. ↑ Favaloro EJ, Lippi G (April 2019). "Recent Advances in Mainstream Hemostasis Diagnostics and Coagulation Testing". Semin Thromb Hemost. 45 (3): 228–246. doi:10.1055/s-0038-1676579. PMID 30912101. S2CID 85517668.


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